Provider Demographics
NPI:1083976906
Name:COVENANT COMPANION CARE, LLC
Entity Type:Organization
Organization Name:COVENANT COMPANION CARE, LLC
Other - Org Name:CHRISTIAN COMPANION SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-242-2273
Mailing Address - Street 1:5106 S U ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3610
Mailing Address - Country:US
Mailing Address - Phone:479-242-2273
Mailing Address - Fax:479-242-0752
Practice Address - Street 1:5106 S U ST STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3610
Practice Address - Country:US
Practice Address - Phone:479-242-2273
Practice Address - Fax:479-242-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care